PDF(Pubmed)
Abstract：
OBJECTIVE: To assess key birth outcomes in an alternative maternity care model, midwifery-based birth center care.
METHODS: The American Association of Birth Centers Perinatal Data Registry and birth certificate files, using national data collected from 2009 to 2019.
METHODS: This observational cohort study compared key clinical birth outcomes of women at low risk for perinatal complications, comparing those who received care in the midwifery-based birth center model versus hospital-based usual care. Linear regression analysis was used to assess key clinical outcomes in the midwifery-based group as compared with hospital-based usual care. The hospital-based group was selected using nearest neighbor matching, and the primary linear regressions were weighted using propensity score weights (PSWs). The key clinical outcomes considered were cesarean delivery, low birth weight, neonatal intensive care unit admission, breastfeeding, and neonatal death. We performed sensitivity analyses using inverse probability weights and entropy balancing weights. We also assessed the remaining role of omitted variable bias using a bounding methodology.
METHODS: Women aged 16-45 with low-risk pregnancies, defined as a singleton fetus and no record of hypertension or cesarean section, were included. The sample was selected for records that overlapped in each year and state. Counties were included if there were at least 50 midwifery-based birth center births and 300 total births. After matching, the sample size of the birth center cohort was 85,842 and the hospital-based cohort was 261,439.
RESULTS: Women receiving midwifery-based birth center care experienced lower rates of cesarean section (-12.2 percentage points, p < 0.001), low birth weight (-3.2 percentage points, p < 0.001), NICU admission (-5.5 percentage points, p < 0.001), neonatal death (-0.1 percentage points, p < 0.001), and higher rates of breastfeeding (9.3 percentage points, p < 0.001).
CONCLUSIONS: This analysis supports midwifery-based birth center care as a high-quality model that delivers optimal outcomes for low-risk maternal/newborn dyads.
METHODS: The American Association of Birth Centers Perinatal Data Registry and birth certificate files, using national data collected from 2009 to 2019.
METHODS: This observational cohort study compared key clinical birth outcomes of women at low risk for perinatal complications, comparing those who received care in the midwifery-based birth center model versus hospital-based usual care. Linear regression analysis was used to assess key clinical outcomes in the midwifery-based group as compared with hospital-based usual care. The hospital-based group was selected using nearest neighbor matching, and the primary linear regressions were weighted using propensity score weights (PSWs). The key clinical outcomes considered were cesarean delivery, low birth weight, neonatal intensive care unit admission, breastfeeding, and neonatal death. We performed sensitivity analyses using inverse probability weights and entropy balancing weights. We also assessed the remaining role of omitted variable bias using a bounding methodology.
METHODS: Women aged 16-45 with low-risk pregnancies, defined as a singleton fetus and no record of hypertension or cesarean section, were included. The sample was selected for records that overlapped in each year and state. Counties were included if there were at least 50 midwifery-based birth center births and 300 total births. After matching, the sample size of the birth center cohort was 85,842 and the hospital-based cohort was 261,439.
RESULTS: Women receiving midwifery-based birth center care experienced lower rates of cesarean section (-12.2 percentage points, p < 0.001), low birth weight (-3.2 percentage points, p < 0.001), NICU admission (-5.5 percentage points, p < 0.001), neonatal death (-0.1 percentage points, p < 0.001), and higher rates of breastfeeding (9.3 percentage points, p < 0.001).
CONCLUSIONS: This analysis supports midwifery-based birth center care as a high-quality model that delivers optimal outcomes for low-risk maternal/newborn dyads.
摘要：
目的：评估替代产妇护理模式中的关键分娩结局，助产中心护理。
方法：美国出生中心协会围产期资料登记和出生证明文件，使用2009年至2019年收集的国家数据。
方法：这项观察性队列研究比较了低围产期并发症风险妇女的关键临床分娩结局，比较在以助产为基础的分娩中心模式和以医院为基础的常规护理中接受护理的患者。与基于医院的常规护理相比，使用线性回归分析来评估基于助产的组的关键临床结局。使用最近邻匹配选择基于医院的组，和主要线性回归使用倾向评分权重（PSW）进行加权。考虑的关键临床结局是剖宫产，低出生体重,新生儿重症监护病房入院，母乳喂养,新生儿死亡。我们使用逆概率权重和熵平衡权重进行了敏感性分析。我们还使用边界方法评估了省略变量偏差的剩余作用。
方法：16-45岁低风险妊娠妇女，定义为单胎胎儿，没有高血压或剖宫产的记录，包括在内。选择样本用于在每年和州中重叠的记录。如果至少有50个基于助产的分娩中心分娩和300个总分娩，则包括县。匹配后,出生中心队列的样本量为85,842,医院队列为261,439.
结果：接受基于助产的分娩中心护理的妇女剖宫产率较低（-12.2个百分点，p<0.001)，低出生体重(-3.2个百分点，p<0.001)，NICU入院（-5.5个百分点，p<0.001)，新生儿死亡（-0.1个百分点，p<0.001)，和更高的母乳喂养率（9.3个百分点，p<0.001)。
结论：该分析支持基于助产的分娩中心护理作为一种高质量的模式，为低风险的孕产妇/新生儿双胎提供最佳结果。
方法：美国出生中心协会围产期资料登记和出生证明文件，使用2009年至2019年收集的国家数据。
方法：这项观察性队列研究比较了低围产期并发症风险妇女的关键临床分娩结局，比较在以助产为基础的分娩中心模式和以医院为基础的常规护理中接受护理的患者。与基于医院的常规护理相比，使用线性回归分析来评估基于助产的组的关键临床结局。使用最近邻匹配选择基于医院的组，和主要线性回归使用倾向评分权重（PSW）进行加权。考虑的关键临床结局是剖宫产，低出生体重,新生儿重症监护病房入院，母乳喂养,新生儿死亡。我们使用逆概率权重和熵平衡权重进行了敏感性分析。我们还使用边界方法评估了省略变量偏差的剩余作用。
方法：16-45岁低风险妊娠妇女，定义为单胎胎儿，没有高血压或剖宫产的记录，包括在内。选择样本用于在每年和州中重叠的记录。如果至少有50个基于助产的分娩中心分娩和300个总分娩，则包括县。匹配后,出生中心队列的样本量为85,842,医院队列为261,439.
结果：接受基于助产的分娩中心护理的妇女剖宫产率较低（-12.2个百分点，p<0.001)，低出生体重(-3.2个百分点，p<0.001)，NICU入院（-5.5个百分点，p<0.001)，新生儿死亡（-0.1个百分点，p<0.001)，和更高的母乳喂养率（9.3个百分点，p<0.001)。
结论：该分析支持基于助产的分娩中心护理作为一种高质量的模式，为低风险的孕产妇/新生儿双胎提供最佳结果。
